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Questions and Answers
Which of the following is NOT a common side effect associated with SSRIs?
Which of the following is NOT a common side effect associated with SSRIs?
- Trouble sleeping
- Weight gain (correct)
- Nervousness
- Nausea
How are SSRIs primarily metabolized and excreted in the body?
How are SSRIs primarily metabolized and excreted in the body?
- Excreted in bile and metabolized in the intestines
- Directly absorbed into the bloodstream and metabolized in the kidneys
- Absorbed in the stomach and excreted through perspiration
- Metabolized in the liver and excreted in urine and feces (correct)
Which of the following conditions could SSRIs potentially exacerbate?
Which of the following conditions could SSRIs potentially exacerbate?
- Insomnia
- Asthma
- Hypertension
- Angle-closure glaucoma (correct)
Off-label uses for SSRIs include treatment for which of the following?
Off-label uses for SSRIs include treatment for which of the following?
Which of the following nursing considerations is crucial before prescribing SSRIs?
Which of the following nursing considerations is crucial before prescribing SSRIs?
What is the primary action of SSRIs in the treatment of depression?
What is the primary action of SSRIs in the treatment of depression?
Patients with which condition should exercise caution when prescribed SSRIs?
Patients with which condition should exercise caution when prescribed SSRIs?
The half-life of SSRIs varies widely. What does this variability primarily affect?
The half-life of SSRIs varies widely. What does this variability primarily affect?
Which of the following is a common side effect of tricyclic antidepressants?
Which of the following is a common side effect of tricyclic antidepressants?
What is a significant pharmacokinetic property of tricyclic antidepressants regarding their absorption?
What is a significant pharmacokinetic property of tricyclic antidepressants regarding their absorption?
Which condition should be considered cautiously when prescribing tricyclic antidepressants?
Which condition should be considered cautiously when prescribing tricyclic antidepressants?
Which of the following is NOT an off-label use for tricyclic antidepressants?
Which of the following is NOT an off-label use for tricyclic antidepressants?
What nursing consideration is essential when monitoring a patient on tricyclic antidepressants?
What nursing consideration is essential when monitoring a patient on tricyclic antidepressants?
Tricyclic antidepressants primarily work by affecting which of the following neurotransmitters?
Tricyclic antidepressants primarily work by affecting which of the following neurotransmitters?
What serious side effect of tricyclic antidepressants may require immediate medical attention?
What serious side effect of tricyclic antidepressants may require immediate medical attention?
Which of the following side effects is most likely due to the anticholinergic effects of tricyclic antidepressants?
Which of the following side effects is most likely due to the anticholinergic effects of tricyclic antidepressants?
Which of the following patient populations should be approached with caution when prescribing antidepressants due to increased risk of adverse effects?
Which of the following patient populations should be approached with caution when prescribing antidepressants due to increased risk of adverse effects?
What is a significant interaction concern when prescribing tricyclic antidepressants (TCAs)?
What is a significant interaction concern when prescribing tricyclic antidepressants (TCAs)?
Which condition should be assessed prior to prescribing antidepressants to avoid severe adverse reactions?
Which condition should be assessed prior to prescribing antidepressants to avoid severe adverse reactions?
What is a critical nursing consideration when starting a patient on MAOIs?
What is a critical nursing consideration when starting a patient on MAOIs?
What potential effect should be considered in children and young adults when prescribing antidepressants?
What potential effect should be considered in children and young adults when prescribing antidepressants?
What vital sign assessment is particularly important prior to beginning treatment with antidepressants?
What vital sign assessment is particularly important prior to beginning treatment with antidepressants?
What is a common barrier to using MAOIs in the treatment of depression?
What is a common barrier to using MAOIs in the treatment of depression?
Which of the following symptoms may indicate a shift in a manic-depressive patient initiated on antidepressants?
Which of the following symptoms may indicate a shift in a manic-depressive patient initiated on antidepressants?
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Study Notes
Selective Serotonin Reuptake Inhibitors (SSRIs)
- SSRIs are a common class of antidepressants that work by increasing the availability of serotonin in the brain.
- Common SSRIs: Sertraline (Zoloft), Fluoxetine (Prozac, Sarafem), Citalopram (Celexa), Escitalopram (Lexapro), Paroxetine (Paxil, Pexeva, Brisdelle), Fluvoxamine (Luvox)
- Common Side Effects: Nausea, sleep disturbances, nervousness, tremors, sexual problems.
- Other uses: Obsessive-compulsive disorder (OCD), panic disorder, bulimia, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), hot flashes, anxiety.
How SSRIs Work
- Serotonin is a brain chemical involved in mood regulation.
- Depression is associated with lower levels of serotonin (and other brain chemicals).
- SSRIs prevent serotonin from being reabsorbed by the brain, increasing the amount available.
- SSRIs do not cause the body to produce more serotonin, they just enhance its use.
- Pharmacokinetics: SSRIs are absorbed in the gastrointestinal tract, metabolized in the liver, and excreted in urine and feces. The half-life varies depending on the specific drug.
Nursing Considerations for SSRIs
- Assess for Allergies: Gather history of past allergic reactions to SSRIs.
- Patient History: Screen for severe depression, angle-closure glaucoma, bipolar disorder, impaired liver or kidney function, pregnancy, and breastfeeding.
- Caution: Be watchful for patients with angle-closure glaucoma, urinary retention, prostate hypertrophy, recent GI/genitourinary surgery, psychiatric problems, manic-depressive disorders, history of seizures, and elderly patients. Hepatic or renal impairment can interfere with drug metabolism and excretion.
Interactions with SSRIs
- Alcohol: Reduces SSRI effectiveness and increases sedation.
- Tricyclic antidepressants: Can increase the effects of epinephrine, potentially leading to high blood pressure and heart rhythm problems.
Monoamine Oxidase Inhibitors (MAOIs)
- Older antidepressants that work by preventing the breakdown of neurotransmitters like norepinephrine, dopamine, and serotonin.
- MAOIs interact with many drugs, foods, and supplements, and can't be combined with stimulants or other antidepressants.
- Nursing Considerations: Assess for allergies, impaired liver/kidney function, history of seizures/psychiatric problems/suicidal thoughts, medication interactions, and baseline vital signs.
Tricyclic Antidepressants (TCAs)
- Prescribed when SSRIs or other antidepressants are ineffective.
- **Common TCAs:**Amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin, imipramine (Tofranil)
Side Effects of TCAs
- Common: Constipation, dry mouth, fatigue.
- Serious: Low blood pressure, irregular heart rate, seizures.
How TCAs Work
- TCAs increase the availability of serotonin and norepinephrine in the brain, which are thought to affect mood.
- Used off-label for conditions like OCD, bedwetting, migraines, chronic pain, and panic disorder.
- TCAs affect the body's autonomic nervous system, blocking histamine and causing side effects like drowsiness, blurred vision, dry mouth, constipation, and glaucoma.
Pharmacokinetics of TCAs
- Well absorbed in the gastrointestinal tract, reaching peak levels within 2-4 hours.
- Highly bound to plasma proteins, and easily cross the placenta and enter breast milk.
Cautions for TCAs
- Patients with pre-existing cardiovascular disorders are at risk due to the cardiac stimulatory effect of the drug.
- Any condition exacerbated by anticholinergic effects requires caution.
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